Book review: Natural Causes: Life, Death and the Illusion of Control by Barbara Ehrenreich

Review by John Carey

Polemical: Barbara EhrenreichBLOOMBERG/GETTY

The Sunday Times, April 1 2018

Barbara Ehrenreich is an award-winning American columnist with a penchant for telling America what it does not want to hear. In Smile or Die (2010), written after she was diagnosed with breast cancer, she derided the American craze for “positive thinking”. In cancer support-groups, she was surprised to find, positive thinking was widely held to help arrest the disease — a belief unsupported by scientific evidence and on a par, in her view, with magic. Further, the idea that thinking positively about what you want helps you to get it, has, she contends, undermined US culture far beyond the sphere of cancer treatment. It might have been one cause of the financial crash.

Her new book also centres on the mind-body divide, but the target of her satire this time is the multibillion-dollar “wellness” industry with its thousands of luxury gyms and health resorts, its personal health monitors, now worn by a third of American consumers, and its corporate wellness programmes designed, she asserts, to prevent flabby people getting hired or promoted.

Wellness, she observes, is now a class-marker. Smoking and obesity identify you as socially inferior. She once spent three months living on the minimum wage as a waitress, hotel maid and cleaner, and wrote up the results in Nickel and Dimed (2001). Blue-collar jobs, she found, are more stressful and put more strain on the body than white-collar, which is why smoking, alcoholism, opioid abuse and suicide are more common among the poor. Wellness is a luxury.

At the other end of the social scale her new book investigates a number of Silicon Valley billionaires. Insulated from reality by their vast wealth and technical genius, some of them, she finds, actually believe they will live for ever by reprogramming their biochemistry. She blames them not just for hubris but for destroying America’s mind. Thanks to iPads, iPhones and computers, the average adult American’s attention span has shrunk, in a dozen years, from 12 to 8 seconds, which, she says, is less than the attention span of a goldfish.

This is good news for the pharmaceutical industry, which has developed drugs to treat attention-deficit disorder in school-age Americans, or at least those with rich parents. It has also boosted the cult of “mindfulness”, based loosely on a vulgarised form of Buddhism. There are now more than 500 mindfulness apps for your iPhone to escape from the modern world into age-old serenity.

Natural Causes is an autobiography as well as a polemic. Looking back over her life, Ehrenreich, now in her mid-seventies, finds that what she dislikes most are doctors. They have never been her favourite people. She opted to give birth to her first child, in 1970, in a public clinic, where she was the only white patient. It was late in the evening and the doctor, anxious to get home, induced labour. Ehrenreich was furious, and it made her a feminist. She does not repeat that anecdote here, but there is much else about the medical profession in Natural Causes, and little to its credit.

An older runner in AmericaDAVID MADISON/GETTTY

Doctors, she alleges, aim to dominate patients, especially women. They see women’s bodies as their exclusive property, and their over-medicalisation of childbirth makes women feel powerless, demeaned and dirty. Doctors’ white coats and masks, although justified by a “veneer” of science and hygiene, are really part of a ritual of humiliation comparable, Ehrenreich suggests, to rituals among the Ndembu of Zambia. Her tirade has its own passionate appeal, but it risks sounding peevish and ungrateful. After all, the medicalisation of childbirth in America, where she was lucky enough to have her children, must be one reason why the infant mortality rate there is 10 times lower than in Zambia.

The last section of her book is the most eccentric, as she turns her attention to selfhood. It is the self, she believes, that makes death scary because we are terrified by the thought of a world without us in it. She thinks the idea of the self was invented in the 17th century, which can’t be true, for Socrates’s famous precept, “know thyself”, evidently assumes there is a self to know, but history is not her strong point. The discovery, in recent years, that some cells in the immune system actually aid the growth of tumours, is, she feels, another blow to the idea of a “self”, because it shows the body is divided against itself. That, too, seems questionable, because when people talk of their “selves” they generally mean their thoughts, memories and imaginings, not their cellular structure, which few know anything about.

Her third reason for doubting human selfhood is that it is too exclusive a claim. We may, she believes, have millions of “selves” inside us with their own aims and intentions. She read science at university and wrote a PhD on the immune system, so she knows from experience that some cells act in ways we cannot predict or understand, as subatomic particles do. Perhaps, she thinks, they make decisions — although when she suggests this on the phone to a cell specialist, he guffaws. All the same, she clings to the idea that the world is not dead (as, she believes, science alleges), but teeming with life.

This can be experienced, she claims, if you take the psychedelic drug psilocybin. Patients who have tried it undergo a magical loss of self and a radiant vision of an animated universe. It seems she has not read Aldous Huxley’s classic The Doors of Perception (1954), where he describes the “ego-less” realm of radiant beauty he entered after taking mescaline. Even the folds of his grey-flannel trousers became “a labyrinth of endlessly significant complexity”. It was like the world Adam saw in Eden (minus the trousers, of course). What neither Huxley nor Ehrenreich explains is why taking a hallucinogen should give you a truer view of the universe than, say, getting extremely drunk. That aside, the wit and fighting spirit of this book show no sign of failing powers and will delight Ehrenreich’s many admirers.